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Electroconvulsive Therapy and Other Depression Treatments

When medication fails to ease the symptoms of clinical depression, there are other options to try. Brain stimulation techniques such as electroconvulsive therapy (ECT), for example, can be used to treat major depression that hasn't responded to standard treatments.

The least invasive of these techniques is called transcranial magnetic stimulation (TMS), in which electric pulses are sent by a device held to the forehead to the prefrontal cortex, the region of the brain that is connected to mood. 

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Vagus nerve stimulation (VNS) uses a pacemaker-like device known as a vagus nerve stimulator to alleviate depression. With ECT, an electric current is briefly applied through the scalp to the brain, inducing a seizure. 

In addition, alternative therapies such as yoga and hypnosis sometimes work for mild depression.

What Is Electroconvulsive Therapy (ECT)?

ECT is among the safest and most effective treatments available for depression. With ECT, electrodes are put on the patient's scalp and a finely controlled electric current is applied while the patient is under general anesthesia. The current causes a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients. It's also very effective for patients who suffer from mania or other mental illnesses.

ECT is generally used when severe depression is unresponsive to other forms of therapy. Or it might be used when patients pose a severe threat to themselves or others and it is too dangerous to wait until medications take effect.

Although ECT has been used since the 1940s and 1950s, it remains misunderstood by the general public. Many of the procedure's risks and side effects are related to the misuse of equipment, incorrect administration, or improperly trained staff. It is also a misconception that ECT is used as a "quick fix" in place of long-term therapy or hospitalization. Nor is it correct to believe that the patient is painfully "shocked" out of the depression. Unfavorable news reports and media coverage have contributed to the controversy surrounding this treatment.

How Is ECT Performed?

Prior to ECT treatment, a patient is given a muscle relaxant and is put to sleep with a general anesthesia. Electrodes are placed on the patient's scalp and a finely controlled electric current is applied. This current causes a brief seizure in the brain.

Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding it, and is often confused. The confusion typically lasts for only a short period of time.

ECT is usually given up to three times a week for a total of two to four weeks.

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